Provider Demographics
NPI:1306029897
Name:EDWARD P.CHUDZIKIEWICZ
Entity Type:Organization
Organization Name:EDWARD P.CHUDZIKIEWICZ
Other - Org Name:MARLBORO CHIROPRACTIC HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:CHUDZIKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-481-1133
Mailing Address - Street 1:340 MAPLE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3200
Mailing Address - Country:US
Mailing Address - Phone:508-481-1133
Mailing Address - Fax:508-229-0609
Practice Address - Street 1:340 MAPLE ST STE 101
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3200
Practice Address - Country:US
Practice Address - Phone:508-481-1133
Practice Address - Fax:508-229-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39116Medicare PIN